1、Lymphatic System 淋巴系统淋巴系统qAccessory circulation of the cardiovascular systemqTransports and filters the tissue fluid,produces lymphocytes and participates in the immune responsesLymphatic capillaryLymphLymphatic System 淋巴系统淋巴系统Lymphatic nodeHeart Artery Capillaries Vein Lymphatic vesselLymphatic tru
2、nkLymphatic duct90%Lymphatic capillary120ml/h10%淋巴淋巴 lymphCell Tissue fluidComposition of the Lymphatic Systemq Lymphatic vessels 淋巴管淋巴管Lymphatic capillary 毛细淋巴管毛细淋巴管Lymphatic vessels 淋巴管淋巴管Lymphatic trunks:淋巴干淋巴干（九条）（九条）Lymphatic ducts:淋巴导管淋巴导管 lthoracic duct 胸导管胸导管lright lymphatic duck 右淋巴导管右淋巴导管q
3、Lymphatic tissue 淋巴组织淋巴组织qLymphatic organ 淋巴器官淋巴器官Lymphatic nodes 淋巴结淋巴结Spleen 脾脾thymus 胸腺胸腺Tonsil 扁桃体扁桃体Lymphatic capillary 毛细淋巴管毛细淋巴管qBegin blindlyqThe wall is composed of a single layer of overlapping endothelial cellsqThey are numerous and form complex networks qBe fund in all tissue and organs
4、of the body except（abscent in）the central nervous system,the eyeball,the internal ear,the epidermis of the skin,the cartilage,and the boneLymphatic vessel 淋巴管淋巴管qHave valves that give them a beaded appearanceqTwo setsSuperficial set:lie in the superficial fascia Deep set:run with blood vessels and n
5、ervesqPasses through at least one lymph node and often several淋巴干淋巴干Lymphatic trunk右淋巴导管右淋巴导管右颈干右颈干右支气管纵隔干右支气管纵隔干左锁骨下干左锁骨下干胸导管胸导管乳糜池乳糜池左腰干左腰干右腰干右腰干肠干肠干左颈干左颈干右锁骨下干右锁骨下干左支气管纵隔干左支气管纵隔干q淋巴干淋巴干Lymphatic trunk左、右颈干左、右颈干jugular trunkl头颈部头颈部左、右支气管纵隔干左、右支气管纵隔干bronchomediastinal trunks l胸腔脏器、部分胸腹壁胸腔脏器、部分胸腹壁左、
6、右锁骨下干左、右锁骨下干subclavian trunk l上肢、部分胸壁上肢、部分胸壁左、右腰干左、右腰干lumbar trunkl下肢、盆部、腹腔成对下肢、盆部、腹腔成对器官、部分腹壁器官、部分腹壁肠干肠干intestinal trunkl腹腔不成对脏器腹腔不成对脏器右淋巴导管右淋巴导管右颈干右颈干右支气管纵隔干右支气管纵隔干左锁骨下干左锁骨下干胸导管胸导管乳糜池乳糜池左腰干左腰干右腰干右腰干肠干肠干左颈干左颈干右锁骨下干右锁骨下干左支气管纵隔干左支气管纵隔干 Thoracic duct 胸导管胸导管qBegins in front of lower border of T12 as a
7、dilated sac,the cisterna chyli 乳糜池乳糜池,which formed by joining of left and right lumbar trunks and intestinal trunkqEnter thoracic cavity by passing through the aortic hiatus of the diaphragm and ascends along on the front of the vertebral column,between thoracic aorta and azygos veinqTravels upward,
8、veering to the left at the level of T5左锁骨下干左锁骨下干胸导管胸导管乳糜池乳糜池左腰干左腰干右腰干右腰干肠干肠干左颈干左颈干左支气管纵隔干左支气管纵隔干左锁骨下干左锁骨下干胸导管胸导管乳糜池乳糜池左腰干左腰干肠干肠干左颈干左颈干 Thoracic duct 胸导管胸导管qAt the roof of the neck,it turns laterally and arches forwards and descends to end by entering the left venous angleqJust before termination,it
9、receives the left jugular,subclavian and bronchomediastinal trunksqDrains lymph from lower limbs,pelvic cavity,abdominal cavity,left side of thorax,and left side of the head,neck and left upper limb左支气管纵隔干左支气管纵隔干右腰干右腰干 Right lymphatic duct 右淋巴导管右淋巴导管qFormed by union of right jugular,subclavian,and b
10、ronchomediastinal trunksqEnds by entering the right venous angleqReceives lymph from right half of head,neck,thorax and right upper limblymph node 淋巴结淋巴结qSmall oval or bean-shaped bodesqAfferent vessels enter the node on its convex surface,and afferent vessels leave the node at its concave surfaceth
11、e hilumqArranged in groups,along the blood vesselsqTwo setsSuperficial set:lie in the superficial fascia Deep set:lie with blood vesselsqRegional lymph nodes 局部淋巴结局部淋巴结Lymph nodes of the head qLocated at junction of head and neckqConsist of Occipital lymph nodes 枕淋巴结枕淋巴结Mastoid lymph nodes 乳突淋巴结乳突淋巴
12、结Parotid lymph nodes 腮腺淋巴结腮腺淋巴结 Submandibular lymph nodes 下颌下淋巴结下颌下淋巴结 lies near the submandibular gland,receive lymphatic vessels from the face,nose and mouthsubmental lymph nodes 颏下淋巴结颏下淋巴结qDrain into deep cervical lymph nodes 颈深淋巴结颈深淋巴结Lymph nodes of the neckqAnterior cervical ln.颈前淋巴结颈前淋巴结Superf
13、icial anterior cervical ln.颈前浅淋巴结Deep anterior cervical ln.颈前深淋巴结lPrelaryngeal lymph nodes 喉前淋巴结lThyroid lymph nodes 甲状腺淋巴结lPretracheal lymph nodes 气管前淋巴结lParatracheal lymph nodes 气管旁淋巴结Lymph nodes of the neckqLateral cervical ln.颈外侧淋巴结颈外侧淋巴结 Superficial lateral cervical ln.颈外侧浅淋巴结颈外侧浅淋巴结lLie along
14、the external jugular veinDeep lateral cervical ln.颈外侧深淋巴结颈外侧深淋巴结lExtend along the internal jugular veinLymph nodes of the neckqDeep lateral cervical ln.颈外侧深淋颈外侧深淋巴结巴结Extend along the internal jugular vein from the base of skull to the root of necklsuperior deep lateral cervical ln.颈外颈外侧上深淋巴结侧上深淋巴结li
15、nferior deep lateral cervical ln.颈外颈外侧下深淋巴结侧下深淋巴结 Efferent vessels form the jugular trunk 颈干颈干Receive lymphatic vessels from head,neck,tongue,larynx,cervical parts of esophagus and trachea,thyroid gland,upper parts of the thoracic wall and breastLymph nodes of the neckqSuperior deep lateral cervical
16、 ln.颈外侧上深淋巴结颈外侧上深淋巴结Jugulodigastric ln.颈内静脉二腹肌淋巴结颈内静脉二腹肌淋巴结 lLies at the junction of posterior belly of digastric and internal jugular veinlDrain the nasopharynx,palatine tonsil and root of tougueJuguloomohyoid ln.颈内静脉肩胛舌骨肌淋巴结颈内静脉肩胛舌骨肌淋巴结 lLies at the junction of the intermediate tendon of omohyoid
17、and internal jugular veinlDrain the apex of tongueSpinal accessory ln.副神经淋巴结Lymph nodes of the neckqInferior deep lateral cervical ln.颈外侧下深淋巴结颈外侧下深淋巴结Supraclavicular lymph nodes 锁骨上淋巴结锁骨上淋巴结 lLie along transverse cervical a.&v.lScalene ln.斜角肌淋巴结斜角肌淋巴结Efferent vessels form the jugular trunk 颈干颈干lLeft
18、 jugular trunk joins the thoracic duct lRight jugular trunk joints the right lymphatic ductLymph nodes of the neckqRetrophrangeal ln.咽后淋巴结咽后淋巴结Lying vertically behind the pharynxLymph nodes of upper limbqCubital lymph node 肘淋巴结肘淋巴结 lies above medial epicondyle of humerusqInfraclavicular nodes 锁骨下淋巴结
19、锁骨下淋巴结 qAxillary lymph node 腋淋巴结腋淋巴结 Axillary lymph nodesqAxillary lymph nodes vary in size from a pin-head to a large bean.qThey are arranged in five groups 胸肌淋巴结胸肌淋巴结Pectoral ln.外侧淋巴结外侧淋巴结Lateral ln.肩胛下淋巴结肩胛下淋巴结Subscapular lymph node 中央淋巴结中央淋巴结Central ln.尖淋巴结尖淋巴结Apical ln.尖淋巴结尖淋巴结中央淋巴结中央淋巴结外侧淋巴结外侧
20、淋巴结肩胛下淋巴结肩胛下淋巴结胸肌淋巴结胸肌淋巴结Axillary lymph nodesPectoral lymph nodes 胸肌淋巴结胸肌淋巴结qLying along the lower border of pectoralis minor behind the pectoralis majorqReceive lymph vessels from the lateral quadrants of the breast and superficial vessels from the anterolateral abdominal wall above the level of th
21、e umbilicusAxillary lymph nodesLateral lymph nodes 外侧淋巴结外侧淋巴结qAlong medial side distal part axillary veinqReceives lymph from upper limbAxillary lymph nodesSubscapular lymph node 肩胛下淋巴结肩胛下淋巴结qLying along subscapular vessels,in front of the subscapularis qReceive superficial lymph vessels from the ba
22、ck,down as far as the level of the iliac crestsqEfferents above three groups pass to central lymph node Axillary lymph nodesCentral lymph node 中央淋巴结中央淋巴结qLying in the center of the axilla in the axillary fat qReceive lymph from the above three nodesqEfferents pass to apical lymph node Axillary lymph
23、 nodesApical lymph node 尖淋巴结尖淋巴结qLying at the apex of the axilla at the lateral border of the fist rib qReceive lymph the efferent lymph vessels from all the other axillary nodes and superior region of breastqThe efferents of the apical nodes form the subclavian trunkLeft subclavian trunk joins the
24、thoracic duct Right subclavian trunk joints the right lymphatic ductAxillary lymph nodesLateral ln.Pectoral ln.Subscapular ln.Central ln.Apical ln.Subclavian trunkLymphatic drainage of thoraxqThe lymphatic drainage of thoracic wallTo axillary lymph nodesTo parasternal lymph nodes(along internal thor
25、acic vessels)To intercostals lymph nodes from deeper structureslymph nodes of the thoraxlymph nodes of the thoracic wallqParasternal ln.胸骨旁淋巴结qIntercostal ln.肋间淋巴结qSuperior phrenic ln.膈上淋巴结lymph nodes of the thoraxqPulmonary ln.肺淋巴结肺淋巴结 Lie in the angles of bifurcation of branching lobar bronchiqBro
26、nchopulmonary hilar ln.支气管肺门淋巴结支气管肺门淋巴结Lie in the hilus of the lungqTracheobronchial ln.气管支气管淋巴结气管支气管淋巴结Situated above or below the bifurcation of tracheaq Paratracheal ln.气管旁淋巴结气管旁淋巴结 Along each side of the trachealymph nodes of the thoraxq Anterior mediastinal lymph node纵隔前淋巴结纵隔前淋巴结 Lies anterior
27、to the large blood vessels of thoracic cavity and pericardiumThe efferents unite with those of paratracheal lymph nodes and parasternal lymph nodes to form the right and left bronchomediastinal trunks 支支气管纵隔干气管纵隔干The left bronchomediastinal trunk terminates in thoracic duct,and right in the right ly
28、mphtic ductqPosterior mediastinal lymph nodes纵隔后淋巴结纵隔后淋巴结 Lie along the esophagus and thoracic aortaLymph nodes of lower limbqPopliteal ln.腘淋巴结腘淋巴结Embedded in the fatty connective tissue of popliteal fossaReceive superficial lymphatic vessels from posterolateral part of calf,and from deep lymphatic
29、vessels accompanying anterior and posterior tibial a.Efferents pass to the deep inguinal ln.q inguinal lymph nodes 腹股沟淋巴结腹股沟淋巴结Superficial inguinal lymph nodes 腹股沟浅淋巴结腹股沟浅淋巴结Deep inguinal lymph nodes 腹股沟深淋巴结腹股沟深淋巴结Lymph nodes of lower limbq Superficial inguinal lymph nodes 腹股沟浅淋巴结腹股沟浅淋巴结Superior gro
30、up lLies just distal to the inguinal ligamentlReceive lymph vessels from anterior abdominal wall below umbilicus,gluteal region,perineal region,external genital organsInferior grouplLies vertical along the terminal great saphenous v.lReceives all superficial lymph vessels of lower limb,except for th
31、ose from the posterolateral part of calf lEfferent vessels drain into the deep inguinal ln.or external iliac ln.Lymph nodes of lower limbq Deep inguinal lymph nodes 腹股沟深淋巴结腹股沟深淋巴结Lie medial to the femoral v.Receive deep lymph vessels of lower limb,perineal region,and efferent vessels from the superf
32、icial inguinal ln.Drain into the external iliac ln.Lymphangiogram showing the inguinal lymph vessels and nodes.Lymph nodes of pelvisqInternal iliac ln.髂内淋巴结髂内淋巴结Surround internal iliac vesselsReceive afferents from pelvic viscera,perineum,buttock and back of thighqExternal iliac ln.髂外淋巴结髂外淋巴结Lie alo
33、ng external iliac arteryReceive afferents from lower limb and some parts of pelvic visceraqCommon iliac ln.髂总淋巴结髂总淋巴结Lie along common iliac arteryReceive afferents from all the above nodesEfferent pass to lumbar lymph node qSacral lymph node 骶淋巴结Lymph nodes of abdomen-abdominal wallTo axillary lymph
34、 node from region above umbilicusTo superficial inguinal lymph node from region below umbilicusTo lumbar lymph node from post wall of abdomenLymph nodes of abdomenLumbar lymph nodes 腰淋巴结腰淋巴结Lie on posterior abdominal wall,along the abdominal aorta and inferior vena cavaReceive lymph from kidneys,sup
35、rarenal glands,testes,ovaries,fundus of uterus,ovary,and common iliac nodesefferent vessels form the Right and left lumbar trunksLymph nodes of abdomen-abdominal wallq Unpaired organs celiac lymph nodes superior mesenteric ln.inferior mesenteric ln.qPaired organslumbar lymph nodesIntestinal trunkLym
36、ph nodes of abdomenqRight and left gastric ln.胃左、右淋巴结胃左、右淋巴结Lie along the same vessels and finally to the celiac ln.qRight and left gastroomental ln.胃网膜左、右淋巴结胃网膜左、右淋巴结Lie along the same vessels,the former drain into subpyloric ln.,the latter drain into splenic ln.qSuprapyloric and subpyloric ln.幽门上、
37、下淋巴结幽门上、下淋巴结Receive lymphatics from pyloric part and finally to the celiac ln.Lymph nodes of abdomenqSplenic ln.脾淋巴结脾淋巴结Receive lymphatics from fundus and left third of stomach,and finally to the celiac ln.qHepatic ln.肝淋巴结肝淋巴结qPancreatic ln.胰淋巴结胰淋巴结q Celiac lymph nodes 腹腹腔淋巴结腔淋巴结 Situated around the
38、 celiac trunk Lymph nodes of abdomenq Superior mesenteric lymph node 肠系膜上淋巴结肠系膜上淋巴结 Situated around superior mesenteric a.q Inferior mesenteric lymph node 肠系膜下淋巴结肠系膜下淋巴结 Situated around inferior mesenteric a.q Intestinal trunk 肠干肠干 Formed by efferent vessel of celiac,superior and inferior mesenteric
39、 lymph nodesqLymphangiogram showing the lateral aortic and proximal iliac lymph nodes.The radiograph was taken approximately 24 hours after the injection of contrast medium into the lymphatics of the dorsum of the foot.Intravenous contrast opacifies the renal collecting system.上肢上肢尖淋巴结尖淋巴结锁骨下干锁骨下干头颈
40、头颈颈外侧深淋巴结颈外侧深淋巴结颈干颈干胸部胸部气管旁淋巴结气管旁淋巴结纵隔前淋巴结纵隔前淋巴结胸骨旁淋巴结胸骨旁淋巴结支气管纵隔干支气管纵隔干 左右左右左右腹部不成对脏器腹部不成对脏器腹腔淋巴结腹腔淋巴结肠系膜上淋巴结肠系膜上淋巴结肠系膜下淋巴结肠系膜下淋巴结肠干肠干腹部成对脏器腹部成对脏器腰淋巴结腰淋巴结腰干腰干乳糜池乳糜池胸导管胸导管右淋巴导管右淋巴导管左静脉角左静脉角右静脉角右静脉角静脉静脉盆盆髂内淋巴结髂内淋巴结髂总淋巴结髂总淋巴结下肢下肢髂外淋巴结髂外淋巴结左左右右Lymph drainage of the breastqLateral and central parts-Pect
41、oral Ln.qSuperior part-Apical Ln.and Supraclavicular Ln.qMedial partDeep-parasternal Ln.Superficial-to the opposite sideqMedial and inferior parts to lymphatic of liver via these of abdomen and diaphragm Lymph edema（elephantiasis）filariid Breast cancer(after LN clearance)filariid filariid Spleen 脾脾q
42、General The largest single mass of lymphoid tissue in the body Reddish in colorProduce,store and destroy the blood cell,and participite in the immune responses q Location:lies in the left hypochondriac region(between stomach and diaphragm)deep to the 9th to 11th ribits long axis corresponds roughly
43、to the 10th ribIts lower pole extends forward only as far as the midline and cannot be palpated on clinical examinationSpleen 脾脾qFeaturesTwo surfaces lDiaphragmatic:smooth,convexlVisceral:concave,hilum of spleenTwo extremities lAnteriorwiderlPosteriorrounderTwo border lSuperiorhas 2-3 splenic notch
44、脾切迹脾切迹,which serve as a landmark on palpation when it is enlarge;normally it is not palpablelInferiorrounderPeritoneal connections of the spleen seen on CT scan.The peritoneal ligaments contain low attenuation fat on CT.The posterior connection is the splenorenal ligament 思考题思考题1.1.淋巴系由哪几部分组成淋巴系由哪几部
45、分组成?2.2.全身有哪些淋巴干？各汇入什么淋巴导管？全身有哪些淋巴干？各汇入什么淋巴导管？3.3.右淋巴导管的组成和注入部位？右淋巴导管的组成和注入部位？4.4.乳糜池如何形成？位于何处？乳糜池如何形成？位于何处？5.5.试述胸导管的起始、行程和注入部位。试述胸导管的起始、行程和注入部位。6.6.腋淋巴结分为哪几群腋淋巴结分为哪几群?7.7.简述乳房的淋巴回流。简述乳房的淋巴回流。8.8.试述试述脾的形态和位置脾的形态和位置q掌握淋巴系统的组成。q掌握全身九条淋巴干的名称、来源、收纳范围 及注流关系。q掌握右淋巴导管与胸导管的合成、注入部位及引流范围。q掌握下颌下淋巴结、颈外侧浅淋巴结和颈外侧深淋巴结的位置及引流范围。q掌握腋淋巴结的分群、各群的位置及引流范围。q掌握支气管肺淋巴结、气管旁淋巴结的位置及收纳范围。q掌握腰淋巴结、腹腔淋巴结、肠系膜上淋巴结、肠系膜下淋巴结的位置及引流范围 q掌握腹股沟浅淋巴结的位置及收纳范围。q掌握脾的形态、位置。q掌握胸腺的形态、位置。
